Assign an external cause code, such as W10.8xxD (Fall (on) (from) other stairs and steps, subsequent encounter) to provide critical detail that will help support the medical necessity of the care your agency is providing.
For example, consider a woman who falls down a stairway and suffers a periprosthetic fracture of her right hip prosthesis. The external cause code W10.8xxD adds valuable information that helps explain to CMS how the woman fractured her joint prosthesis and why she now requires further care, says Brandi Whitemyer, HCS-D, an independent home health and hospice consultant in Canton, Ohio.
And while external cause codes are not required on Medicare home health claims, or any other claims, unless a particular payer or state agency mandates them, using them nevertheless adds an extra layer of protection for your agency. “[I] have spoken to reviewers at Palmetto who say to use [external cause codes],” she says.
Understand the basics of external cause codes
You can’t find an external cause code by searching in the alphabetic index like you would for any other ICD-10 code. Instead, you must begin your search in the Index to External Cause of Injuries.
For example, for a patient injured in a car accident, you might begin your search under “Accident, car” which would send you to “Accident, transport, car occupant.” From there, if the accident occurred in traffic, your code would be V43.92- (Unspecified car occupant injured in collision with other type car in traffic accident).
Then, like any other code, you must verify it in the tabular. Upon looking up V43.92- in the tabular, you’ll notice that it requires a seventh character, either “A” for initial encounter, “D” for subsequent encounter or “S” or sequela. — Megan Batty (mgustafson@decisionhealth.com)
Jun 29, 2018
Diagnosis Coding
AHCC Insider -July 2017